The tarsometatarsal joints allow flexion and extension of the metatarsal bones and a certain degree of supination and pronation of the marginal rays. Sarrafian183 describes the supination and pronation of the first and fifth rays as longitudinal axial rotations. The combination of the sagittal motions and the axial rotations of the first and fifth rays results in a supination and pronation twist of the forefoot, as defined by Hicks. A pronation twist of the forefoot is the result of first ray flexion (plantar flexed) and fifth ray extension (dorsiflexed), whereas a supination twist is a result of first ray extension and fifth ray flexion.